Physician-modified fenestrated/inner-branched endovascular aortic repair for distal aortic arch aneurysm after stent graft migration: a case report

Abstract

Open surgical repair remains the gold standard for aortic arch aneurysms, and endovascular treatment options are limited in high-risk patients. We report successful treatment of a distal aortic arch aneurysm using physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR), suggesting its feasibility as an alternative strategy. A 50-year-old man presented with a distal aortic arch aneurysm enlargement after stent graft migration following preemptive thoracic endovascular aortic repair. The patient had significant neurological sequelae with impaired activities of daily living and was considered unsuitable for conventional arch replacement after multidisciplinary discussion. PM-F/iBEVAR was performed, and an inner branch was sutured only to the left subclavian artery in this patient. Although a type II endoleak was detected on postoperative day 3, the type Ia endoleak had resolved, and patency of the arch branch vessels was well maintained. The patient was discharged without any complications. At 6 months, the aneurysm remained stable without enlargement. This case report suggests that PM-F/iBEVAR may be a feasible option for patients at high risk for open surgical repair with anatomically challenging distal aortic arch aneurysms.